TRICARE is leading the way for all carriers to begin to examine the reimbursement rates paid for creams and topical treatment drugs typically provided by compounding pharmacies. Starting just two months ago, TRICARE began a review and audit program focusing on creams and other topical treatments containing high cost components. The difference between the cost of the drugs to the pharmacist and ultimately the reimbursement from the carrier can be thousands, if not tens-of-thousands of dollars. A cost of $1,000 for the components of a compounded topical treatment can easily be billed and paid at $15,000.
It came to the attention of TRICARE when its budget for reimbursements to compounding pharmacies was exceeded well before the one year budget term anticipated. They began to examine the fact that more military individuals with war related injuries were coming home and naturally this accounted for higher that expected expenditures. However the study also uncovered the huge spread between cost and reimbursements.
Audits now in place are determining the appropriate rates to pay and will ultimately lead to other pharmaceutical payors to re-examine their payments as well.
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